轻度至中度慢性阻塞性肺疾病对接受化疗的非小细胞肺癌患者可行性及预后的影响。
Impact of mild to moderate COPD on feasibility and prognosis in non-small cell lung cancer patients who received chemotherapy.
作者信息
Omote Norihito, Hashimoto Naozumi, Morise Masahiro, Sakamoto Koji, Miyazaki Shinichi, Ando Akira, Nakahara Yoshio, Hasegawa Yoshinori
机构信息
Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan.
出版信息
Int J Chron Obstruct Pulmon Dis. 2017 Dec 11;12:3541-3547. doi: 10.2147/COPD.S149456. eCollection 2017.
BACKGROUND
Non-small cell lung cancer (NSCLC) is the predominant cause of death in patients with COPD, and the severity of COPD in NSCLC patients is classified mainly as mild to moderate. Most advanced NSCLC patients with mild to moderate COPD are treated with chemotherapy; however, the feasibility for and prognosis after chemotherapy of these patients are not well understood. The aim of this study was to elucidate the impact of mild to moderate COPD on the feasibility for and prognosis after chemotherapy in NSCLC patients.
PATIENTS AND METHODS
A retrospective review was performed on 268 NSCLC patients who received first-line chemotherapy from 2009 to 2014 in our institution. Finally, 85 evaluable patients were included in this study. The clinical characteristics, toxicity profile, objective response rate, and prognosis were analyzed and compared between patients with mild to moderate COPD and those without COPD (non-COPD).
RESULTS
Forty-three patients were classified as COPD (27 cases mild and 16 cases moderate) and 42 patients as non-COPD. The COPD group were older and had fewer never-smokers than the non-COPD group. The objective response rate did not differ between groups (=0.14). There was no significant difference in overall survival between COPD and non-COPD groups (15.0 and 17.0 months, log-rank test =0.57). In the multivariate Cox's proportional hazard model, the adjusted hazard ratio (HRadj) was statistically significant for male sex (HRadj =5.382, 95% CI: 1.496-19.359; =0.010), pathological diagnosis of adenocarcinoma (HRadj =0.460, 95% CI: 0.223-0.948; =0.035), and epithelial growth factor receptor negative mutation (HRadj =6.040, 95% CI: 1.158-31.497; =0.033), but not for the presence of COPD (HRadj =0.661, 95% CI: 0.330-1.325; =0.24). Toxicity profile in COPD group was favorable, as in the non-COPD group.
CONCLUSION
Mild to moderate COPD did not have a significant deleterious impact on toxicity and prognosis in NSCLC patients.
背景
非小细胞肺癌（NSCLC）是慢性阻塞性肺疾病（COPD）患者的主要死因，NSCLC患者中COPD的严重程度主要分类为轻度至中度。大多数患有轻度至中度COPD的晚期NSCLC患者接受化疗；然而，这些患者化疗的可行性和化疗后的预后尚不清楚。本研究的目的是阐明轻度至中度COPD对NSCLC患者化疗可行性和化疗后预后的影响。
患者与方法
对2009年至2014年在我院接受一线化疗的268例NSCLC患者进行回顾性研究。最终，85例可评估患者纳入本研究。分析并比较轻度至中度COPD患者与无COPD（非COPD）患者的临床特征、毒性特征、客观缓解率和预后。
结果
43例患者分类为COPD（27例轻度，16例中度），42例患者为非COPD。COPD组患者比非COPD组年龄更大，从不吸烟者更少。两组间客观缓解率无差异（P=0.14）。COPD组和非COPD组总生存期无显著差异（分别为15.0个月和17.0个月，对数秩检验P=0.57）。在多因素Cox比例风险模型中，调整后风险比（HRadj）在男性（HRadj=5.382，95%CI：1.496-19.359；P=0.010）、腺癌病理诊断（HRadj=0.460，95%CI：0.223-0.948；P=0.035）和表皮生长因子受体阴性突变（HRadj=6.040，95%CI：1.158-31.497；P=0.033）方面有统计学意义，但COPD的存在无统计学意义（HRadj=0.661，95%CI：0.330-1.325；P=0.24）。COPD组的毒性特征与非COPD组一样良好。
结论
轻度至中度COPD对NSCLC患者的毒性和预后没有显著有害影响。
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